Rx for Danger: Oxycodone crackdown drives addicts to other drugs

For years, oxycodone reigned as the prescription drug of choice for dealers and abusers in Florida.

The painkiller was so widely prescribed in the Sunshine State that just two years ago, 90 of the top 100 oxycodone-buying physicians in the nation were from Florida.

But a major crackdown by law enforcement, a new prescription-drug-monitoring database, legislation and other factors have caused a significant reduction in the amount of oxycodone available in Florida.

And the streets are feeling it.

"Our street sources tell us that the crackdown on pain clinics has had a definite impact on the price and availability of oxycodone," said Volusia County Sheriff's Office spokesman Gary Davidson. "We're still working about the same number of pill-related cases as in the past, although there has been a small uptick in morphine seizures."

Central Florida law enforcers say oxycodone is hard to come by these days, and when abusers and dealers can find the drugs they need, the pills can get prohibitively expensive.

Authorities say Central Florida physicians are prescribing less oxycodone now than in the past, partly because they're now being tracked by the Prescription Drug Monitoring Program. Some local pharmacists also are reluctant to fill prescriptions they think might be suspect.

That means abusers are turning to other drugs, such as the painkiller hydromorphone, investigators say.

And there are concerns across the country that heroin use could rise, and that overdoses could increase as abusers try drugs they aren't familiar with.

In Seminole County, narcotics investigators say they are seeing more hydromorphone on the streets, but it's not because that is the preferred drug.

"It is because it is cheaper and easier to acquire than oxycodone," said Sheriff's Office spokeswoman Heather Smith.

Law-enforcement officials in Orange County said they have encountered people with illegal hydromorphone during traffic stops, undercover buys and even when they're assisting the Department of Children and Families during child-welfare checks, according to a review of local arrest reports.

On a recent afternoon in east Orange County, deputies say, James Franklin Frost walked into a Walgreens on East Colonial Drive, implied he had a gun and placed a note on the pharmacy counter demanding prescription drugs.

He got away with about 600 Dilaudid pills, a brand name forhydromorphone, before being spotted by deputies in a wooded area near the pharmacy.

Agents with the Metropolitan Bureau of Investigation, the task force that investigates prescription-drug cases in Orange and Osceola counties, say an oxycodone pill today can cost about $30 on the street.

In comparison, a Dilaudid pill will run about $15.

MBI Director Larry Zwieg said if addicts can't get their oxycodone, they're most likely going to try another drug.

That observation was mirrored in a national study recently published in the New England Journal of Medicine that looked at the illicit use of OxyContin before and after the painkiller was reformulated to make it more difficult to crush — a deterrent to abuse.

Of those surveyed, 66percent said they switched to another opioid after OxyContin was reformulated in 2010, and the most common drug shift was to heroin.

There also was an increase in the number of people who chose hydromorphone and fentanyl, a painkiller more potent than morphine, as their primary drug.

The researchers wrote that their data showed the harder-to-crush OxyContin formula reduced abuse of that drug but caused abusers to find replacement drugs, including heroin.

Researcher Theodore J. Cicero, a professor at Washington University in St. Louis, said it's logical that some oxycodone abusers would switch to heroin, as the painkiller is often crushed and snorted or injected.

"The worrisome thing about this switch with all these drugs is people who were accustomed to oxycodone ... are suddenly now forced to use other drugs that they may not be familiar with," Cicero said.

That change in drug use, Cicero said, could lead to accidental overdoses.

According to recent data from the Substance Abuse and Mental Health Services Administration, 81percent of people who stated using heroin from 2008 to 2010 had previously abused prescription drugs.

"The public-health and safety threat that heroin and the abuse of prescription painkillers pose to our nation is devastating," Hallberg said. "While heroin use is still far less common than prescription-drug abuse, we must ensure that the federal government — in close coordination with state and local authorities — responds effectively and in a balanced way to any emerging trends."

Though some of the patients in Cicero's study reported a switch to heroin, Central Florida law enforcers say they aren't seeing any significant shift to heroin as a preferred drug.

But that doesn't mean abusers are giving up drugs.

"At the end of the day, you've got thousands or hundreds of thousands of people who are addicted to drugs," said Florida Department of Law Enforcement Special Agent Danny Banks. "And when the drugs that they are addicted to become less available, they are going to need to find some other type of drug to fuel their addiction."